Ntrprof ph1/ntrnet/ehr 11-20
CPT 99447 is used when a physician or qualified healthcare professional provides a telephone or internet consultation to another treating physician or healthcare professional, spending 11-20 minutes discussing a patient's care.
RVU breakdown
Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High
Billing tips
Document exact start and stop times of the interprofessional discussion to substantiate the 11-20 minute time range
Impact: Critical for audit defense; underdocumented time is the #1 denial reason, potentially costing the full $34.61 reimbursement
Ensure both verbal and written report are provided and documented; this is a required component of 99447
Impact: Missing written report component triggers automatic denials; proper documentation protects full reimbursement
Verify the consultation was requested by another treating physician or appropriate healthcare professional with documented evidence of the request
Impact: Self-initiated consultations are not billable under 99447; missing request documentation results in 100% denial
Do not bill 99447 for the same patient encounter if you have billed face-to-face E/M services within the previous 7 days or during the next 14 days
Impact: Violates Medicare bundling rules; can trigger recoupment of $34.61 plus potential audit flags
Bill 99447 under the consulting physician's NPI, not the requesting physician; only the consultant can bill for this service
Impact: Incorrect NPI results in immediate claim rejection; delays payment by full billing cycle
Count only the medical consultative time spent reviewing records and discussing the patient, not administrative tasks or record preparation
Impact: Including non-consultative time may lead to upcoding allegations; use correct time tier to avoid compliance risk
Applicable modifiers
When to use: Not typically applicable to 99447 as it is a professional service without a technical component
Reimbursement impact: Would result in denial; do not append
When to use: When the interprofessional consultation occurs via synchronous telemedicine or real-time interactive audio and video telecommunications
Reimbursement impact: May be required by some payers for telehealth services; does not typically change reimbursement rate
When to use: When a principal physician of record requests consultation from another physician
Reimbursement impact: Informational; no direct payment impact but clarifies billing relationship
When to use: When service performed in part by a resident under teaching physician supervision in teaching settings
Reimbursement impact: Required for proper teaching physician billing; may affect compliance but not payment rate
Common denials
Insufficient time documentation - time not clearly documented or falls outside the 11-20 minute range
How to appeal: Submit appeal with exact start/stop times from medical record, call logs, or EHR timestamps showing 11-20 minutes of consultative discussion. Include attestation from consulting provider confirming time spent.
Missing written report component - only verbal consultation documented without written summary
How to appeal: Provide copy of written consultation report sent to requesting physician, including date/time stamp. Reference specific documentation in medical record or secure message system showing written component was completed and transmitted.
No documented consultation request from treating physician
How to appeal: Submit evidence of consultation request such as telephone note, secure message, EHR consultation order, or written request from treating physician. Include requesting physician's name, NPI, and date of request.
Service bundled with recent E/M visit - billed within restricted timeframe of other services
How to appeal: Document that consultation was for a separate, unrelated clinical issue or provide timeline showing service falls outside the 7-day prior/14-day post restriction period. May need to withdraw claim if legitimately bundled.
Frequently asked questions
What is CPT code 99447 used for?
CPT 99447 is used to bill for an interprofessional telephone, internet, or EHR consultation between healthcare professionals that lasts 11-20 minutes. The consulting physician reviews patient information and provides both verbal and written recommendations to the treating physician who requested the consultation, without direct patient contact.
How much does Medicare pay for CPT 99447 in 2025?
Medicare pays $34.61 for CPT 99447 in 2025 based on the national average non-facility rate. The code has 1.07 total RVUs (0.7 work RVU, 0.31 practice expense RVU, 0.06 malpractice RVU) multiplied by the 2025 conversion factor of 32.3465.
Can I bill 99447 for phone calls with other doctors about my patients?
You can only bill 99447 if another physician or qualified healthcare professional specifically requests your expert consultation, you spend 11-20 minutes in medical consultative discussion and review, and you provide both verbal and written reports. Informal phone calls, care coordination discussions, or self-initiated consultations do not qualify for 99447 billing.
What is the difference between CPT 99447 and 99448?
CPT 99447 covers interprofessional consultations lasting 11-20 minutes, while 99448 covers consultations lasting 21-30 minutes. The codes differ only in time duration; all other requirements (consultation request, written report, no face-to-face contact) are identical. Accurate time documentation determines which code to use.
Do I need patient consent to bill CPT 99447?
While patient consent is generally good practice, 99447 is a provider-to-provider consultation service that does not involve direct patient contact. Medicare does not explicitly require patient consent for interprofessional consultations, though your facility or state may have specific policies. The consultation must benefit the patient's care and be appropriately documented.
Can CPT 99447 be billed with an office visit on the same day?
No, CPT 99447 cannot be billed if you have provided face-to-face E/M services to the same patient within 7 days before or 14 days after the consultation. If you will see the patient in person within these timeframes, the interprofessional consultation is considered part of the face-to-face evaluation and management service.
What documentation is required to support billing CPT 99447?
Required documentation includes: evidence of the consultation request from the treating provider, exact start/stop times showing 11-20 minutes of consultative discussion, clinical summary of the patient's condition, your assessment and recommendations, and proof that a written report was sent to the requesting provider. Missing any of these elements can result in claim denial.